Pituitary and skull‐base lesions and the litigious patient

Wang, Alan C.; Darlin, Spencer; Lai, Wanda; Svider, Peter F.; Jacob, Jeffrey T.; Liu, James K.; Eloy, Jean Anderson; Folbe, Adam J.

doi:10.1002/alr.21999

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…A relatively modest rate of neurovascular complications, including cerebrovascular accident, paralysis, and CN palsy, was reported among analyses included (detailed in Section IX.A.2.). Nonetheless, the intimate proximity of critical structures necessitates the inclusion of these risks in a comprehensive preoperative informed consent process, because perceived deficits in informed consent have been raised in litigation related to skull‐base surgery …”

Section: Clival Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Clival Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

Self Cite

150

279

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“…operation!” OR “atrophic rhinitis” OR “empty nose syndrome” OR “dry nose syndrome” AND “dismissed” OR “dismissal” OR “nonsuit” OR “non-suit” OR “summary judgement”This database is commonly used by attorneys as a reliable source for locating publicly filed court documents in the United States and has been used previously in publications across several disciplines of medicine to report on medicolegal issues. 4–6 As the data from this database was deidentified, this retrospective records review met exclusion criteria for needing review by the University of Washington Human Subjects Review Board.…”

Section: Methodsmentioning

confidence: 99%

Medical Malpractice Allegations in Nasal Turbinate Surgery

Coppess

Weymuller²,

Davis

2021

Am J Rhinol�Allergy

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Background Despite studies showing most patients significantly improve their nasal congestion with surgical management of nasal turbinates, not all achieve acceptable results. Rarely, patients report substantial worsening of symptoms leading to litigation risk. Objective Document the United States medicolegal environment for nasal turbinate surgery. Methods We searched the Westlaw database for turbinate related terms for 1987- July 2019, recording demographics, claims, legal arguments, and outcomes in legal cases related to nasal turbinate surgery. We assessed prevalence and correlations with case outcomes. Results Of the 39 cases identified, the most common complaint was nose/facial pain (53.8% of cases). Surgeons prevailed in 87.2% of cases, with total liabilities of $3,224,606 [mean $97,715.3, ±$283,900.8]. Surgeons had statistically significant favorable outcomes when patients claimed dryness, headache, congestion, crusting, breathing problems, and disfigurement (all p < 0.05). Revision surgery was indicated in 23.1% of cases and was claimed in 40.0% of patient awards. Surgical negligence was claimed in 40.0% of patient awards versus 67.9% of surgeon awards (p = 0.333). Lack of informed consent was claimed in 20.0% of patient awards versus 32.1% of surgeon awards (p = 0.601). Conclusions There are inherent litigation risks for surgeons when performing nasal turbinate surgery. Most claims against surgeons, are resolved in favor of the surgeon. Understanding the types of claims and legal arguments that are made by patients could help assessing the risks of a proposed litigation. Documenting clear indications for surgery and written informed consent may reduce litigations against surgeons.

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“…In the current litigious environment that characterizes the practice of medicine, the medicolegal risks of not performing nasal endoscopy need to be further determined. Malpractice litigation has had an impact on the practice of all aspects of Otolaryngology, including sinonasal disease and endoscopic skull base surgery [10][11][12][13]. As the pandemic continues and as there are risks for subsequent "waves" this fall and winter, guidelines for when imaging can be considered in lieu of nasal endoscopy can be a helpful resource on which to fall back.…”

Section: Liability Implications Of Not Performing Nasal Endoscopymentioning

confidence: 99%

COVID-19 and rhinology: A look at the future

Setzen¹,

Svider

Pollock³

2020

American Journal of Otolaryngology

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The novel Coronavirus has created a deadly pandemic that is now significantly impacting the United States. Otolaryngologists are considered high risk for contracting disease, as the virus resides in the nasal cavity, nasopharynx, and oropharynx. While valuable work has been publicized regarding several topics in Rhinology, we discuss other aspects of our specialty in further detail. There are several issues regarding Rhinologic practice that need to be clarified both for the current epidemic as well as for future expected "waves." In addition, as the pandemic dies down, guidelines are needed to optimize safe practices as we start seeing more patients again. These include protocols pertinent to safety, in-office Rhinologic procedures, the substitution of imaging for endoscopy, and understanding the appropriate role of telemedicine. We discuss these aspects of Rhinology as well as practical concerns relating to telemedicine and billing, as these issues take on increasing importance for Rhinologists both in the present and the future. (P.F. Svider).Am J Otolaryngol xxx (xxxx) xxxx 0196-0709/

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Pituitary and skull‐base lesions and the litigious patient

Cited by 7 publications

References 23 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Medical Malpractice Allegations in Nasal Turbinate Surgery

COVID-19 and rhinology: A look at the future

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